Original Report| Volume 17, ISSUE 8, P904-910, August 2016

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The Development of a Technology-Based Hierarchy to Assess Chronic Low Back Pain and Pain-Related Anxiety From a Fear-Avoidance Model


      • The motion-captured, computer-generated avatars engaged in several motions that are typically feared by those with chronic low back pain.
      • These avatars were seen as realistic by both individuals with chronic low back pain and physical therapists.
      • Participants in the study were successfully able to create a hierarchy of fears by ranking the behaviors performed by the avatars.
      • Initial reliability and validity of the virtual human assessment was established.


      Previous studies have not examined the assessment of chronic low back pain (CLBP) and pain-related anxiety from a fear avoidance model through the use of motion-capture software and virtual human technologies. The aim of this study was to develop and assess the psychometric properties of an interactive, technologically based hierarchy that can be used to assess patients with pain and pain-related anxiety. We enrolled 30 licensed physical therapists and 30 participants with CLBP. Participants rated 21 video clips of a 3-D animated character (avatar) engaging in activities that are typically feared by patients with CLBP. The results of the study indicate that physical therapists found the virtual hierarchy clips acceptable and depicted realistic patient experiences. Most participants with CLBP reported at least 1 video clip as being sufficiently anxiety-provoking for use clinically. Therefore, this study suggests a hierarchy of fears can be created out of 21 virtual patient video clips paving the way for future clinical use in patients with CLBP.


      This report describes the development of a computer-based virtual patient system for the assessment of back pain-related fear and anxiety. Results show that people with back pain as well as physical therapists found the avatar to be realistic, and the depictions of behavior anxiety- and fear-provoking.

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